Archives for June 2016

We know that stress can age you prematurely, but what do we need to do to prevent unhealthy aging? This is exactly what this review by cardiologist Dr. Joel Kahn has done. It points out that the right lifestyle makes the difference.

Studies showing how to prevent unhealthy aging

Several studies have shown how to avoid getting heart disease, cancer and diabetes.

Kahn reported that in 2001 the Harvard School of Public Health published a study where 84,941 healthy female nurses had been followed who were free of heart disease, cancer and diabetes at baseline. But only 3.4% of the 84,941 women managed to stay healthy after 16 years of the study. The secret? Their body mass index (BMI) was less than 25.0, their diet was high in polyunsaturated fat and fiber, low in trans fat and low in glycemic load, they engaged in regular moderate exercise with a minimum of 30 minutes per day; they did not smoke and they drank ½ an alcoholic drink per day. Their risk to get diabetes was 91% lower than the rest of the study. This shows you how powerful lifestyle choices are.

In 2004 an international study (the INTERHEART study) reported in the Lancet the lifestyle of 15,152 cases that developed heart attacks in 52 countries with 14,820 controls who did not have heart attacks. The researchers found 9 risk factors that accounted for 90 to 95% of the heart attacks. They were smoking, elevated cholesterol risk ratio, diabetes, high blood pressure, abdominal obesity, stress, low intake of fruit and vegetables, high alcohol intake and lack of physical exercise. Obesity was considered a high risk when the waist circumference measured more than 35 inches in a woman or more than 40 inches in a man. All these 9 risks can be eliminated by lifestyle changes.

The 2006 Health Professional Study spanned over 16 years in a group of 40 to 75 year old doctors without a heart attack at baseline. It noted that male doctors who were lacking the 5 heart attack risk factors had 87% less heart attacks than controls without health lifestyles. What were the lifestyle factors? A body mass index (BMI) of less than 25, being a nonsmoker, being physically active for more than 30 minutes a day, having not more than moderate amounts of alcohol intake and having a diet that was more than 40% plant based.

In 2007 a Swedish study reported on 24,000 women after menopause that had no heart attacks initially. After 6 years of follow-up 308 women developed heart attacks. An analysis showed what the risk factors were for those who developed heart attacks. Those who did not have these risk factors reduced their risk of getting a heart attack by 92%. What lifestyle factors were protective? Four factors were identified: a low-risk diet (consisting of high vegetable and high fruit intake, whole grains, legumes, fish and moderate alcohol intake), not smoking, walking or biking 40 minutes daily and a low waist circumference.

In 2008 the Harvard University released a study that was a further follow-up of the Health Professional study with more than 43,000 men and also the Nurses’ Health Study with more than 71,000 women. The question here was what would prevent the development of strokes? The investigators found that in both groups stroke risk could be reduced by 50% when the following 5 lifestyle factors were adhered to: no smoking, keep the BMI below 25, exercise at least 30 minutes daily with moderate activity, don’t exceed a modest alcohol intake, have a diet intake in the top 40% of fruit and vegetables and whole grains.

A 14 yearlong study from the Netherlands was published in 2014, where almost 18,000 men and women without heart disease at the beginning of the study were followed. More than 600 heart attacks occurred throughout the study. People who stuck to 4 lifestyle habits reduced their heart attack rates by 67%; if they adhered to 5 lifestyle factors they reduced the heart attack rate by 83%. The 4 initial lifestyle factors were: doing an average of 30 minutes of physical activity per day, eating a Mediterranean style diet rich in fruit and vegetables and whole grains, not smoking and having more than one alcoholic drink per month. This gave you a reduced risk of your heart attack rate by 67%. Add one more good habit: sleep 7 or more hours per night on average. This reduces the risk of you getting a heart attack by 83%!

A Swedish heart study with initially more than 20,000 men was going on for 11 years. There were 5 lifestyle habits the investigators identified as essential to reduce heart attack rates. Unfortunately only 1% of the study group adopted all 5 lifestyle factors, but they dropped their chance of getting a heart attack or dying of a heart attack by 86%. The lifestyle factors were: a diet rich in fruit and vegetables, legumes, nuts, whole grains and low fat; not smoking, moderate alcohol consumption, thin waistline and more than 40 minutes of physical activity.

Preserving health and vitalityto prevent unhealthy aging

There is a clear pattern in all of these large studies. A healthy lifestyle preserves your health by keeping your joints and muscles in good working order. Your heart and lungs are staying well conditioned, because you engage in cardiovascular training every day. This keeps your nitric oxide going, which is an important signaling molecule that in turn reduces your blood pressure.

When we remove disabling diseases like strokes and heart attacks and prevent diabetes from developing, life expectancy is increasing. When people remain physically active even in old age, this translates into fewer disabilities and less frailty. Even Alzheimer’s disease is observed to occur less when good lifestyle habits are adhered to.

Prevent Unhealthy Aging

Conclusion

The studies cited here show how lifestyle factors can make a significant difference in preventing heart attacks and strokes. In the past even doctors ignored the risk of smoking. A few years back conventional medicine negated that lifestyle factors could make a difference. Now we have more studies than we need to prove that this is so. It is more important that we adhere to as many of the lifestyle factors identified in these studies to make a real difference in our lives. We also need to set an example to the next generation and to our peers. Adopting healthy lifestyle factors has to become a cultural habit for society at large. This will help reduce healthcare costs, but most importantly this will help you and me to live longer, healthier lives.

The cancers investigated were colon cancer, breast cancer, and lung and bladder cancer. As people do absorb vitamin D3 differently, the researchers found that the best way to measure vitamin D3 concentration in the body is to use serum 25-hydroxyvitamin D (25(OH)D). In the past not much attention was paid to this matter. However, several studies including the present study showed that in patients who had a lower level of 20 ng/ml cancer rates were higher.

The researchers used data from two prior studies, a randomized clinical trial of 1,169 women and a prospective cohort study of 1,135 women. The researchers found that the age-adjusted cancer incidence was 1,020 cases per 100,000 person-years in the randomized clinical trial, called “Lappe cohort”. The other prospective cohort study was called the “GrassrootsHealth cohort” with an age-adjusted cancer incidence of 722 per 100,000 person-years. The interesting fact was that the Lappe cohort median blood serum level of 25(OH)D was 30 nanograms per milliliter, while the GrassrootsHealth cohort had a higher level of 25(OH)D of 48 ng/ml. This likely explains the lower cancer rate in the GrassrootsHealth cohort. In order to increase the statistical significance the two trials were combined. The striking finding was that above 40 ng/ml the overall cancer risk was more than 71% lower than for the group of people whose level of 25(OH)D was 20 ng/ml or lower. The above ScienceDaily article was based on this scientific study.

Other studies showing high vitamin D3 prevents cancer

In a 2015 study Afro American men were found to have 71% less prostate cancer, if their serum 25-hydroxyvitamin D level was at least 30 ng/ml or higher.

This 2006 study reported a 14-year prospective follow-up in men where all cancers were counted and blood serum 25-hydroxyvitamin D levels were correlated to cancer incidence. An increase of 25 nmol/L (=10 ng/ml) in predicted serum 25(OH)D level was associated with a 17% reduction in total cancer incidence, with a 29% reduction in total cancer mortality and a 45% reduction in digestive-system cancer mortality. These investigators stated that it takes about 1500 IU of vitamin D3 increase per day to achieve an increment of serum 25(OH)D increment of 25 nmol/L (=10 ng/ml).

A publication from the University of Arizona Cancer Center in Jan. 2016 is more critical of the evidence regarding vitamin D3 and the claim that it lowers cancer rates. They reviewed the cancer literature and found that for colorectal cancer there is a clear inverse relationship between serum 25(OH)D levels on the one hand and rates and mortality of colorectal cancer on the other hand. However, with breast cancer the literature was more divided. Only higher vitamin D levels were related to a lower risk for progression of breast cancer and a lower mortality rate. Randomized, double-blind clinical trials with regard to breast cancer failed to show effectiveness on cancer prevention or reduction of mortality. For prostate cancer conditions were similar with the exception of a study using 4000 IU of vitamin D3 per day, which inhibited progression of prostate cancer.

In a mouse model using a carcinogen to induce ovarian cancer there was an inverse dose-relationship between vitamin D3 and ovarian tumor development both in tissue culture and in the animal.

How high vitamin D3 prevents cancer

Several studies have attempted to speculate how vitamin D3 may prevent cancer. Chirumbolo summarized the literature and noted that vitamin D3 has been shown to function as an immune cytokine stimulating the immune system non-specifically. Vitamin D3 is also anti-inflammatory and counters insulin resistance and inflammatory kinins in obesity. Flavonoids with their antioxidant activity are also cancer preventing. As we know that low levels of vitamin D are associated with higher cancer frequency it is important to use vitamin D3 as supplements in our diet.

This Chinese study examined the effects of vitamin D3 on cancer prevention. It found that vitamin D3 combines three specific actions in one. Vitamin D3 is anti-proliferative meaning that it stops uncontrolled cell division. Secondly, it has an apoptotic (cell death) effect, which means it supports the removal of cells that are dying. If they are dying, but not removed, cancer can occur from these cell remnants. The third effect of vitamin D3 is that it has differentiating effects in several malignant cell types. When cancer cells are non-differentiated (=more immature cells) cancer can multiply quickly. When cancer cells are becoming more specific cells uncontrolled multiplication is much more difficult. This is an effect that controls the speed by which cancer cells divide and how quickly cancer metastasizes.

High Vitamin D3 Prevents Cancer

Conclusion

There still is some confusion about the effects of vitamin D3 regarding cancer prevention. In colorectal cancer the statistics are clear: vitamin D3 can significantly prevent colorectal cancer to a large extent. There are also preventative effects in breast cancer and prostate cancer, but individuals may have to take at least 4000 IU of vitamin D3 or more. This is particularly true in higher latitudes where sunlight exposure is lower in the wintertime. Also, people absorb vitamin D3 differently. For this reason it is important to at least check your serum 25-hydroxyvitamin D levels on a few occasions. This will tell you whether your vitamin D3 supplementation is sufficient. Aim for levels in the 50-80 ng/ml, which is health promoting.

Apart from cancer prevention vitamin D3 is also important for prevention of cardiovascular disease (particularly in diabetics), osteoporosis and Alzheimer’s disease.

An April 2016 study from Indiana University found that drugs can cause dementia. There were 451 people enrolled in the study with an average age of 73. 60 of them were taking at least one or more anticholinergic drugs. Anticholinergic drugs are drugs that inhibit the neurotransmitter acetylcholine in nerves or in the brain. The end result is that spasms in the stomach, bowel or bladder are relieved. Also the many over-the-counter sleep medications that may contain anticholinergic drugs help you to fall asleep easier. In the above-mentioned study researchers measured the effects that the drugs have, using different tests. They used memory and cognitive tests to check for memory loss, reasoning and judgment. PET scans were used for measuring brain metabolism. MRI scans were used to look for structural brain changes.

Results on how anticholinergic drugs can cause dementia

Memory tests and cognitive function tests showed that those taking anticholinergic drugs did worse on memory tests, verbal reasoning, problem solving and planning. The PET scan showed that glucose utilization by the brain was down in those who were taking anticholinergic drugs. The hippocampus was particularly affected with lower glucose utilization. This is the center where short-term memory is processed. It is also the area where Alzheimer’s patients have been found to have problems with early memory loss.

MRI scans showed that there were structural brain changes in the patients that were using anticholinergic drugs. Their brains had reduced brain volume (brain atrophy) and the brain cavities in the brain, called ventricles were enlarged. Overall this meant that their brains had much less brain cells when compared to controls that did not take anticholinergic drugs.

In a 2013 study from the Indiana University researchers had established that it took only 60 days of taking cholinergic drugs to cause cognitive problems. Using drugs with only weak anticholinergic side effects, it took up to 90 days before the same cognitive deterioration could be measured.

The researchers concluded that it would be wise for physicians to consider switching a patient to medication that does not include anticholinergic side effects to prevent development of dementia or Alzheimer’s disease.

Anticholinergic drugs can cause dementia

In the study above it was stated that it was the group of anticholinergic drugs that was particularly problematic. These are over-the-counter-drugs like sleep aids, antihistamines, and incontinence drugs etc. that were having anticholinergic side effects. The more of these types of drugs are taken, the more interaction can take place, leading to full-blown anticholinergic symptoms. As people age, they collect more and more symptoms and diseases. Physicians tend to treat the symptoms with various medications, so it is not unusual for an elderly person to be on 5 or 6 different drugs. If one or more of these drugs have anticholinergic side effects, this can add up and cause the kind of observations the above mentioned clinical study showed: dementia symptoms and proof that the brain metabolism has been slowed down. The brain also experiences the structural changes of dementia that I mentioned.

Possibility that herbs and drugs can cause dementia

The problem does not stop here. It is possible that over-the-counter herbs that you may innocently get in the health food store can participate in the overall metabolic interaction of anticholinergic substances. Many herbs have pharmacological substances in them that have specific helpful effects. But whenever a drug or herb has a positive effect, quite often there is an undesirable effect or side effect.

Historically Belladonna is a poisonous plant that has medicinal values. Unfortunately many Belladonna preparations are available in health food stores that are not regulated by the FDA. Belladonna has strong anticholinergic side effects that interfere with other anticholinergic side effects.

There are many other herbs that are available without prescription.

Kava-kava is an herb and a hallucinogenic that has anticholinergic properties. Keep in mind that the more you use Kava-Kava, the more your brain gets shut down. Why? The anticholinergic effect of Kava-Kava shuts down acetylcholine, the main stimulus in your brain cells to help you think.

Passionflower is an herb that sedates and is often used as a tincture to help you to fall asleep. What is perceived as a natural effect is merely the anticholinergic effect on the central nervous system.

Hops is the calming compound found in beer. It is also often used together with other sedating herbal sleeping remedies in teas.

St. John’s wort is also on the list. In smaller doses this herbal antidepressant may be useful and may have less side effects than commercial antidepressants. But there are possible side effects of dry mouth and constipation, which are the result of the anticholinergic side effect.

Skullcap is often used in tea to help a person to fall asleep. But keep in mind that the effect of helping you fall asleep comes from the anticholinergic effect of skullcap on brain cells.

All of these herbs are not any different from the medications discussed earlier, except that they are a bit weaker with regard to the anticholinergic effect.

Particularly benzodiazepines, meperidine (an opioid), antidepressants and many other drugs when taken together cause dementia, in part because of additive anticholinergic activity.

In an Edinburgh study from England 34 deceased patients, who were heavily using street drugs were autopsied. Their brains were compared to healthy 16-year-old non-drug users. There was nerve cell damage in the brain area involved with learning, memory and wellbeing. The pathologist found the same dementia findings that would be present in much older Alzheimer patients. We have to conclude from this that the damage was done by the anticholinergic effect of the drugs that were used as a mix in the years prior to their deaths. There can be added toxicity to nerve cells from interacting drugs and their side effects.

Drugs Can Cause Dementia

Conclusion

Whenever you have a substance that helps to get you drowsy so you can sleep better, be careful and check that it is not because of the anticholinergic effect of an herb or an over-the-counter drug. Melatonin is an exception, because this is your body’s own sleeping hormone that your body knows. Whenever anticholinergic drugs or herbs act on your brain they can over time cause an irreversible brain atrophy, which can been shown by MRI scans as in the study mentioned above. This leads to cognitive problems including memory problems. PET scans have also shown a permanent slowdown of glucose metabolism of the brain cells of the hippocampus, where short-term memory is located. Without that function you get permanent dementia. Instead of being treated symptomatically ask your physician for the cause of your symptoms and have the cause treated. You may not always get the answer you need from conventional medicine. As the next step you may want a second opinion from a naturopath to see whether there would be an alternative treatment available that does not involve anticholinergic medications. Go to the root of the problem, avoid drugs that cause damage, and keep your brain healthy and your mental capacities without cognitive deficits!

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Dr. Matt Pratt-Hyatt gave an overview about genetic screening for better health at the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas. The talk was entitled ”Genetic Screening: A Tool for Better Health with Age”. He showed that with more sensitive genetic screening techniques minor genetic changes can be detected. These are a lot more common than previously thought of. Matt Pratt-Hyatt, PhD is Associate Laboratory Director for the Great Plains Laboratory in Lenexa, KS.

Specifically, Dr. Pratt-Hyatt explained that single nucleotide polymorphisms, frequently called SNPs (pronounced “snips”) were the most common type of genetic variations among people. These genetic changes in the DNA often cause disease. Different types of genetic testing can identify the gene defects of SNPs. One of the questions is how aging can be better managed when genetic defects are known.

When it comes to our genetic material there are over 3 billion base pairs, all contained in 23 chromosomes. These are home to 20,000-25,000 genes, most of which are normal.

A gene has three regions all of which can have mutations. In the middle there is the coding region; one end is the regulatory region for transcription initiating; at the other end the transcription termination signals are located. Minor mutations in any of these regions can have major implications for the health of the individual or they can stay silent SNPs. SNPs are classified into missense mutation or nonsense mutation. This description just shows how intricate and complex the process of mutations can be!

Three types of sequencing are commonly used:

Three types of genetic screening for better health

Sanger sequencing utilizes certain dyes that correspond to specific nucleotides of the DNA. The benefits of Sanger sequencing is that it can cover one gene completely. It can find previously unknown mutations. But the disadvantage of Sanger sequencing is that you cannot process a large number of genes.

The Florophore-base detection looks at multiple SNPs in a single run. This method is cheaper than whole genome sequencing. But one of the disadvantages of Florophore-base detection is that only a limited number of SNPs can be processed per run. It also can miss new mutations.

Benefits of next generation sequencing are that it can look at 1000s of SNPs per run. It is much more accurate than previous technologies. A drawback though is that the equipment is much more expensive.

Not all of these tests have to be done, but the physician can make the choice of the appropriate one for the patient. The following are some applications with regard to how genetic screening can be useful for better health.

Detoxification as part of genetic screening for better health

Since the 1970’s and 1980’s it has become clear that there are many steps in the detoxification process in the liver. It involves major enzyme systems that are controlled by the P450 genes. Several genetic defects are known that run in different families. These effects are very important for drug detoxification and metabolism. Any mutation in one of the P450 controlling genes will lead to accumulation of the drug that is normally detoxified by this enzyme system. As any drug has toxicity at higher levels, the consequence is possible toxicity, if the drug is not discontinued or lowered. When people age, they often have spontaneous mutations of the P450 detoxification system and this should be taken into account by doctors who prescribe medications. Common drugs that cause problems with the P450 controlled detoxification are antidepressants, the blood thinner Coumadin, the antibiotic erythromycin, the asthma medication Theophylline and many others.

Here is an example of how important this knowledge is in an elderly patient who was sent to the hospital with an irregular heartbeat. The electrocardiogram allowed a diagnosis of atrial fibrillation. The doctor treated the patient with a cautious loading dose of 0.5 mg of Coumadin in an attempt to thin the blood of the patient. This would prevent a blood clot or a stroke due to the arrhythmia. Normally a small dose like this would not do much in terms of blood thinning, as it would take several days of a low dose like this to achieve blood thinning. Unbeknown to the physician, this patient was different as he had a defect in the Cyp2c9 gene, a subtype of the P450 system. Very quickly the patient developed bleeding gums and bruising of the skin in various locations. When blood tests were taken, the INR, a measure of the clotting system, was 3.7, a value that should not have exceeded a level of 2 to 3. Genetic testing confirmed a homogenous mutation of the Cyp2c9 gene that explained the toxicity of Coumadin in this case, one of the many drugs that is detoxified by the P450 system.

Mental health as part of genetic screening for better health

Many mental illnesses can be caused by defects in various parts of the brain metabolism. This is particularly so when it involves the synthesis of brain hormones. If there are genetic defects, this can lead to the particular brain metabolism that is associated with depression or schizophrenia. Even dementia, Alzheimer’s disease and Parkinson’s disease can be caused by genetic defects. Methylation pathway defects are another source of possible genetic defects, which can affect multiple metabolic pathways. This is the cause of many diverse conditions like autism, diabetes and some hereditary cancers. The reason it is important to be aware of such genetic aberrations is that often vitamin B2, B6, niacin, vitamin B12 and the minerals magnesium and zinc can stabilize a person with methylation defects.

Cholesterol as part of genetic screening for better health

People with obesity have problems with their lipid metabolism, diabetes, high blood pressure and often heart disease and strokes. Changes in cholesterol metabolism are at the center of these problems. Cholesterol is one of the building blocks of cell membranes, and cholesterol is one of the normal components in the blood as long as the subfractions are properly balanced (LDL and the HDL cholesterol). Unfortunately many people have minor or major defects of the biosynthetic pathway of cholesterol. There are 5 genes involved in the acetyl CoA biosynthesis. 21 genes are involved in the main cholesterol biosynthesis pathways. Over 10 genes control cholesterol metabolites. Historically these genes were detected because of various familiar gene defects that caused problems with the biochemical processes surrounding cholesterol. Familial high cholesterol levels (familial hypercholesterolemia) is one of these common conditions.

Patients who have this condition will often have high cholesterol and also often have a family history of gall bladder surgery for gallstones and a history of premature heart attacks or strokes. Early diagnosis and careful clinical intervention can improve the outlook for many patients.

Genetic Screening For Better Health

Conclusion

Not all genetic conditions can be helped by modern medicine. But many minor genetic abnormalities can be worked around or drug interactions can be avoided provided the genetic defect is known. It is encouraging that newer test methods have now shown success, as they are more affordable than in the past. As time progresses the price of these genetic tests will come down even further. Mental health, detoxification pathways and the metabolic syndrome of obesity are practical applications where genetic tests have significance.

Dr. Ray Schilling

Dr. Ray Schilling born in Tübingen, Germany and Graduated from Eberhard-Karls-University Medical School, Tuebingen in 1971. Once Post-doctoral cancer research position holder at the Ontario Cancer Institute in Toronto, is now a member of the American Academy of Anti-Aging Medicine (A4M). [About Dr. Ray Schilling …]